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MsK Lower Limb > (5 & 6) Fractures > Flashcards

(5 & 6) Fractures Flashcards

1
Q

What are the two types of fracture healing?

A

Secondary & Primary

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2
Q

What are the four stages of secondary healing?

A
  • 1: Inflammation and haematoma formation (1-5 days)
  • 2: Formation of cartilaginous (soft) callus (5-11 days)
  • 3: Formation of bony (hard) callus (11-28 days)
  • 4: Bone remodeling (day 21 to months)
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3
Q

What occurs during stage 1 of inflammation and haematoma formation?

A
  • directly after injury
  • haematoma forms from cells of bone marrow, peripheral blood, & intramedullary blood
  • coagulates & forms b/t fracture ends
  • scaffold for callus
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4
Q

What happens during stage 2 of formation of cartilaginous (soft) callus?

A
  • platelets recruited to fracture site
  • triggers inflammatory response
  • brings fibroblasts to site
  • lay down collagen rich fibrocartilaginous network across fracture site
  • blood vessel production
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5
Q

What happens during stage 3 in the formation of bony (hard) callus

A
  • fibroblasts differentiate into osteoblasts
  • commence process of new bone formation adjacent to fracture ends
  • conversion cartilaginous callus to bone
  • bony material produced is cancellous
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6
Q

What happens during stage 4 in bone remodeling?

A
  • osteoclasts & osteoblasts begin remodeling hard callus
  • called ‘coupled remodeling’
  • cancellous bone converted to lamellar bone
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7
Q

What is primary healing?

A
  • no distinct stages
  • occurs when there is a mechanical continuity between fracture fragments (no gap)
  • facilitated by bridging units “cutting cones”
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8
Q

How do “cutting cones” work in primary healing?

A
  • osteoclasts at tip of cones resorb cortical bone
  • creates longitudinal cavities b/t them
  • osteoclast & osteoblast activity and formed at nearest site injury
  • osteoblasts behind osteoclasts produce new bone, filling cavity
  • bridges fracture gap
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9
Q

When does secondary healing most commonly occur?

A
  • most common in non-op
  • can occur within surgical fixation
  • does not require anatomic reduction
  • most fractures heal this way
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10
Q

When does primary healing most commonly occur?

A
  • result rigid, anatomic reduction of bone fragments
  • not commonly result natural process
  • requires fracture ends to be reduced
  • occurs following surgical reduction & fixation
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11
Q

What is the effect of immobility / bedrest on older patients?

A
  • up to 15% drop VO2max & 30% drop FRC after 1 week
  • 25% drop circulatory volume after 1 week
  • 20% drop muscle strength after 1 week
  • decline in walking ability ~2 days
  • 50% incontinent ~1 day
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12
Q

What is the Irish Hip Fracture Database?

A
  • monitors performance of 16 hospitals performing hip fracture surgery in ROI
  • 7 standards to be met
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13
Q

What are the 7 standards of the IHFD?

A
  • patient orthopaedic ward within 4 hours of admission
  • surgery within 48 hours
  • minimise risk of pressure ulcers
  • routine geriatrician
  • bone health assessment
  • special falls assessment
  • mobilisation on day of/after surgery by a physio
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14
Q

What are the 4 types of hip fracture?

A
  • Intracapsular
  • Extracapsular
  • Intertrochanteric
  • Subtrochanteric
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15
Q

What is a hemiarthroplasty?

A

partial hip replacement procedure that involves replacing only the ball portion of the hip joint, not the socket

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16
Q

What are the CSP (2018) hip fracture rehab guidelines?

A
  • physio Ax and mobs day of/after surgery
  • at least 2 hours physio in first week
  • at least 2 hours rehab in subsequent weeks
  • strength, balance, transfers & walking
17
Q

What are the APTA (2021) hip fracture rehab guidelines?

A
  • transfer out bed asap after surgery & daily
  • structured exercise including progressive, resistive strength, balance, WB & functional mobility
  • dynamometry, gait speed test, TUG, CAS
18
Q

What is the physio’s role in exercise rehab?

A
  • check WB status
  • screen & establish baseline
  • home exercise program (HEP)
  • dress patient & transfer out of bed
  • discharge planning
  • outcome measures
  • follow-up following discharge
19
Q

What should be considered for home discharge patients?

A
  • not living alone
  • fell outdoors
  • walking aid
  • do not have dementia
  • low ASA score
  • no major co-morbidities
20
Q

How do distal femur fractures occur?

A
  • fall from standing (elderly)
  • high-energy trauma (young males)
21
Q

What is the physio management for a distal femur fracture?

A
  • mobility education as per WB status
  • wean from aids when possible
  • while in brace, focus on ankle ROM, isometric quads, standing gluteal sets
  • when brace off, ROM to full then stationary bike
  • open & closed chain proprioception
  • plyometrics as per guidelines
22
Q

What causes patella fractures?

A
  • direct impact to patella
  • indirect eccentric contraction
23
Q

What is the physio management for a fractured patella?

A
  • mobility education as per WB status
  • wean from aids once allowed
  • while in cast focus ankle ROM, isometric quads & standing gluteal
  • ROM to full then stationary bike
  • open & closed chain proprioception
  • plyometrics as per guidelines
24
Q

How are tibial plateau fractures scaled?

A
  • Schatzker Classification
  • 1-6
  • Higher number means higher severity
25
Q

What is the physio management for a tibial plateau fracture?

A
  • initially always NWB
  • gait education with walking aid
  • HEP: static quads & glutes, SLR, ankle ROM
  • active knee ROM once brace off
  • progressive knee ROM
  • closed chain strength hip, knee, ankle
  • progress FWB and wean aids
  • proprioception and functional
26
Q

How do fractures of the tibia occur?

A
  • high energy in young patients (fall from height, RTC, sport)
  • low energy in elderly (fall from standing height)
27
Q

When is external fixation useful?

A
  • malunion or non-union
  • after soft tissue flap construction
  • mgmt fractures in patients with fragile skin
  • treatment fractures with significant bone loss
28
Q

What is the physio management for a fractured tibia?

A
  • mobility education as per WB status
  • ankle & knee ROM
  • quads and gluteal sets
  • wean from aids once able
  • ROM restoration through exercise program & manual T
  • open & closed chain resistance programme
  • proprioception & plyos
29
Q

What are the two ankle fracture classifications?

A
  • Dans-Weber
  • Lauge-Hansen
30
Q

What are the Dans-Weber classifications of ankle fracture?

A
  • classifies distal fibula fractures according to position
    A. below ankle syndesmosis
    B. at level ankle syndesmosis
    C. above ankle syndesmosis
31
Q

What are the Lauge-Hansen classifications of ankle fracture?

A
  • classifies according to position of joint at injury
    1. Supination-External Rotation
    2. Pronation-External Rotation
    3. Supination-Adduction
    4. Pronation-Abduction
32
Q

What is the physio management during the immobilisation period of an ankle fracture?

A
  • FWB immediately in cast/boot
  • mobility education based on WB status
  • Knee ROM
  • quads & gluteal sets
33
Q

What is the physio management after the immobilisation period of an ankle fracture?

A
  • ROM restoration through exercise program & manual therapy
  • open & closed chain resistance program for calves
  • wean from aids and restore gait
  • proprioception & plyos
34
Q

How does a calcaneus fracture occur?

A

usually a fall from height

35
Q

How does a metatarsal fracture commonly occur?

A
  • crush injury
  • hindfoot / leg rotation on fixed forefoot
36
Q

What is the physio management for foot fractures?

A
  • mobility education as per weight bearing status
  • for calcaneus, treated like an ankle fracture once out of immobilisation
  • for metatarsal, little physio treatment apart from gait education & advice

MsK Lower Limb (8 decks)

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